Visceral perception in health and functional dyspepsia

Abstract

The symptoms of functional dyspepsia are still unexplained. To evaluate the possible role of abnormal visceral perception, we studied the symptomatic responses and the pressure variations during progressive gastric distension in 10 female healthy control subjects (mean age 33.6 years) and in 10 female patients with functional dyspepsia (mean age 35.2 years). A rubber balloon was positioned 4 cm below the lower esophageal sphincter (LES) and inflated with progressively larger volumes of air by steps of 50 ml; pressures at the gastric fundus and at the LES were continuously recorded by perfused manometric catheters. Each subject was studied on two separate occasions after randomized double-blind administration of either placebo or 20 mg of domperidone. Symptomatic responses and the manometric data were analyzed at the time of the initial recognition of distension (bloating step) and at the time of reporting pain or up to a maximum of 700 ml of balloon inflation (pain or 700-ml step). On placebo, the volumes of gastric distension were more than two times lower in patients than in control subjects at the bloating step (185 +/- 32 ml vs 470 +/- 40 ml, P = 0.001) and at the pain or 700-ml step (265 +/- 54 ml vs 600 +/- 34 ml, P less than 0.005), while the pressure gradients (pressure at inflation steps minus baseline pressure before beginning inflation) were not statistically different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of Duodenal Lipids on Gastric Sensitivity and Relaxation in Patients with Ulcer-Like and Dysmotility-Like Dyspepsia

“…As in many previous studies of the sensory function in patients with FD [3, 4, 5], we observed visceral hypersensitivity in the fasting state in these patients. Gastric hypersensitivity to mechanical balloon distention has been a common finding in most studies on FD comparing sensory thresholds between patients and controls, although this has been shown to be an inconsistent finding [29].…”

“…Functional dyspepsia (FD) is a heterogeneous disorder associated with delayed gastric emptying [1, 2], as well as gastric hypersensitivity to mechanical stimulation [3, 4, 5]and impaired accommodation of the proximal stomach [6, 7]. According to the Rome II criteria [8], patients with FD can be subdivided into ulcer-like dyspepsia (ULD) and dysmotility-like dyspepsia (DLD) based on the most bothersome symptom, which is pain in ULD and discomfort in DLD.…”

The effect of Helicobacter pylori eradication therapy on gastric antral myoelectrical activity and gastric emptying in patients with non‐ulcer dyspepsia

“…The symptoms in non‐ulcer dyspepsia patients may be influenced by various factors including acid secretion, gastric perception, food, psychological factors, biliary tract function, enterogastric bile and other unknown factors 35 –40 . Our data suggest that disturbed gastric emptying caused by H. pylori is one of the factors causing the symptoms in non‐ulcer dyspepsia patients because gastric emptying and symptom score improved significantly, paralleling the eradication therapy in the delayed and rapid gastric emptying groups.…”

Methods for studying naturally occurring human pain and their analogues

“…For example, Kingham and Dawson [57] describe a study in which a latex balloon was swallowed and inflated, producing a pain sensation similar to that reported in naturally occurring GI pain. Bradette et al [9] also examined upper GI stimulation by inserting a balloon at the gastric side of the lower oesophageal sphincter, which was found to successfully induce pain in both patients and healthy participants. These techniques seem to be particularly useful for those interested in studying sensations of fullness, pressure, and general pain.…”